Systemic leukofiltration does not attenuate pulmonary injury after cardiopulmonary bypass.

Pulmonary injury mediated by activated leukocytes is a recognized complication of cardiopulmonary bypass. The aim of this paper is to systematically analyze the effects of systemic leukofiltration within the cardiopulmonary bypass circuit on pulmonary injury and related clinical outcomes. We performed a systematic search to identify randomized controlled trials reporting on the effects of systemic leukofiltration on respiratory parameters. Random effect meta-analytical techniques were applied to identify differences in outcomes between the two groups. Sensitivity and subgroup analyses were undertaken to evaluate study heterogeneity. Incorporating 995 patients, 21 studies satisfied the inclusion criteria. Systemic leukofiltration significantly increased the PaO2/FiO2 ratio within 12 hours of bypass cessation, (weighted mean difference (WMD), 25.97; 95% confidence interval (CI), 3.41-48.53; p = 0.02) but this effect was lost by 24 hours (WMD, 12.98; 95% CI, -7.93-33.89; p = 0.22). Leukofiltration significantly reduced the duration of ventilatory support postoperatively (WMD, -2.11 hours; 95% CI, -0.65 to -3.58; p = 0.005), but had no impact on postoperative chest infection, intensive care length of stay or hospital length of stay. The heterogeneity of the included studies was high, due to poor quality study design and failure to include patients at high risk of pulmonary complications. Systemic leukofiltration may attenuate bypass-related lung injury in the early postoperative period, but this does not seem to translate to clinically significant differences in outcomes.

Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery.

The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique.